Cardiovascular disease among people living with HIV in Brazil.

OBJECTIVES: There is a paucity of data on cardiovascular disease (CVD) among people living with HIV (PLHIV) in resource-limited countries. We assessed factors associated with CVD and the impact of prevalent CVD on all-cause mortality in PLHIV on antiretroviral therapy in Brazil. METHODS: Competing risk-regression to assess factors associated with CVD and all-cause mortality in the HIV-Brazil Cohort Study between 2003-2014. RESULTS: Among 5,614 patients, the rate of CVD was 3.5 (95% confidence interval [95%CI] 2.9-4.3) per 1,000 person years. CVD was associated with older age (adjusted hazard ratio [aHR] 6.4 for >/=55 years versus 250 cells/mm(3) , 95%CI 1.0-3.2, p=0.05). The rate of death was 16.6 (95%CI 15.1-18.3) per 1,000 person years. Death was strongly associated with having had a past CVD event (aHR 1.7 versus no past CVD event, 95%CI 1.1-2.7, p=0.01). CONCLUSIONS: Traditional and HIV-specific factors associated with CVD among PLHIV in Brazil are similar to those identified among PLHIV in high-income countries. PLHIV in Brazil with a history of CVD have a high risk of death. CVD care and treatment remain priorities for PLHIV in Brazil as this population ages and antiretroviral therapy use expands.